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ELECTROMYOGRAPHY
Recording muscle action potentials that occurs spontaneously or in response to volitional or stimulated activation using an extra cellular recording technique is called Electromyography
ELECTROMYOGRAM
An individual record of compound muscle action potentials is called an Electromyogram
NORMAL EMG
Procedure
The procedure of electromyography compares the electrical activity of skeletal muscle fibers at rest and during voluntary activation of muscle
STEPS
1. Insertional activity 2. Activity at rest 3. Activity upon minimal activation and recruitment patterns 4. Activity during maximal activation
Insertional activity
When a needle electrode is inserted into a muscle or moved within it A brief burst of electrical activity Positive or negative high frequency spike in a cluster. Mechanical stimulation or injury of muscles Injury potential crisp static sound It usually stops when the needle stops moving or in the next 2 to 3 seconds
Activity at rest
Electrically silent Spontaneous activity - Abnormality Normal or pathologic
Spontaneous activity
Refers to the electrical activity that may recorded from a fully relaxed muscles after cessation of insertion activity Not produced by voluntary contraction
Monophasic negative potentials Irregular high frequency pattern of discharges 0.5 -3 ms, less than 100 micro volts (10 40) Sea shell sound Spontaneous miniature endplate potentials
Biphasic potentials with initial negativity 3-5 ms,100-200 micro volts Sputtering fat in frying pan Mechanical activation of nerve terminal
Physiological
Age Sex Temperature Fatigue Innervation ratio Fibre density, Propagation velocity,
Parameters
Duration Amplitude Phases (Shape) Rise time Area
Technical
Type of needle electrode Location of needle in the muscles Size of the recoding surface area Choice of oscilloscope sensitivity, sweep, filters, methods of storage and display Activation procedure
Duration
Initial take off to the point of return to base line 5 15 ms Measure of conduction velocity, length of muscle fibre, membrane excitability, and synchrony of muscle fibre of a motor unit Fibres more than 1 mm away from the electrode contribute to the initial and terminal portions of MUP
Amplitude
Peak to peak
Depends upon the size and density of muscle fibres synchrony of firing proximity of needle to the muscle fibre Age temperature muscle examined
Phases
Triphasic ( + - + ) Portion of waveform between the departure and return to the baseline polyphasic More than 4 phases Polyphasic not exceed 5 15 % Turns Some potentials show directional changes without crossing base line Serrated potential - desynchronization
Rise time
Time lag from the initial positive peak to subsequent negative peak Distance of needle electrode from the muscle fibres Less than 500 microseconds acceptable Usually 100 200 microseconds Sharp crisp sound proximity of unit Dull sound reposition the needle closer to the muscle fibres
Area
Integration of the rectified action potential over the duration of either negative spike or entire potential 1. number and diameter of muscle fibre closest to the electrode and their potentials 2. number and diameter of muscle fibres contributing to the recorded potential and their individual potentials 5 20 fibres situated within the radius of 1.5 mm
Recruitment
Activation of number of motor units Size principle Hennemans Small to larger motor units 1. Recruitment of previously inactive motor units 2. More rapid firing of already active units
Interference patterns
Simultaneous activation of different units preclude recognition of individual motor unit potentials Depends Descending input from cortex Number of motor unit capable of discharging Firing frequency Wave form of individual potential Probability of phase cancellation
Cont
Good recruitment complete interference pattern
Normal muscles provide good recruitment with a complete obliteration of the base line on the oscilloscope
ABNORMAL EMG
Insertional activity
Increased Reduced denervation, myotonia and polymyositis
Spontaneous activity
Pathologic : 1. Fibrillations 2. Positive sharp waves 3. Fasciculations 4. Complex repetitive discharges 5. Myotonic discharges 6. Myokymia 7. Neuromyotonia 8. cramp
Fibrillations
Spontaneous depolarization Single muscle fiber Not visible through skin Small amplitude and short duration Biphasic with initial positivity Classical indicator of LMN disorders Rain falling on a roof or wrinkling a tissue paper At least three separate sites within a muscle - abnormal
less than 5 ms, 1 mV (20 - 200 micro volts, 2 ms) Rate of discharge - 2 20 per second Found in denervated muscles Appear after 4 5 weeks
Denervation hypersensitivity, increasing the number of Ach receptor Increase in membrane irritability
Single muscle fiber injured by electrode Associated with fibrillation potential MUP and Myotonic discharges also has same wave form
Fasciculations
Same dimension as MUP but occurs spontaneously Associated with a visible twitch or flicker of a muscle Low pitched thump Discharge rate 50 per second, irregular It seen in normal muscle
Spontaneous depolarization of bundles of muscle fibers or a whole motor unit Origin is not clearly known Spinal cord or any where along the peripheral nerve
CONTRACTION FASCICULATION
During voluntary contraction, muscle twitching may be seen with chronic Neurogenic lesion Enlargement of motor unit
Myotonic discharges
Two types 1. Positive waves 2. Brief spikes Both wave forms recorded after Waxing and waning quality Frequency is 40 100 Hz Dive bomber sound Abnormality in the muscle membrane
needle insertion or voluntary contraction or muscle percussion
Positive sharp waves 2 5 ms in duration Resembling positive sharp waves Brief spikes: Biphasic (+ - ) Less than 5 ms Resembling fibrillation
SPONTANEOUS MUP
Fasciculation Myokymia Neuro myotonia cramps
Myokymia
Neuromyotonia
cramps
Myogenic
SLAP MUP
Short duration, low amplitude and polyphasic
Neurogenic
HALD MUP
Higher amplitude, long duration and Polyphasic
Interference patterns
Fair recruitment partial interference pattern
If there are gaps in recruitment Poor recruitment single unit interference pattern if there are discreet MUP on screen
Cont
Myogenic
No gaps but low amplitude